Central Role of Boari Bladder Flap and Downward Nephropexy in Upper Ureteral Reconstruction

No AccessJournal of UrologyAdult Urology1 Oct 2011Central Role of Boari Bladder Flap and Downward Nephropexy in Upper Ureteral Reconstruction Ryan J. Mauck, Steven J. Hudak, Ryan P. Terlecki, and Allen F. Morey Ryan J. MauckRyan J. Mauck More articles by this author , Steven J. HudakSteven J. Hudak More articles by this author , Ryan P. TerleckiRyan P. Terlecki Current address: Wake Forest University School of Medicine, Winston-Salem, North Carolina. More articles by this author , and Allen F. MoreyAllen F. Morey Financial interest and/or other relationship with GlaxoSmithKline, Pfizer and AMS. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.05.086AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We defined the role of the Boari bladder flap procedure with or without downward nephropexy for proximal vs distal ureteral strictures. Materials and Methods: We retrospectively reviewed the records of all patients who underwent open ureteral reconstruction for refractory ureteral strictures, as done by a single surgeon between 2007 and 2010. Patients were grouped by stricture site into group 1—proximal third of the ureter and group 2—distal two-thirds. Operative techniques and outcomes were reviewed. Results: During the 30-month study period a total of 29 ureteral reconstruction procedures were performed on 27 patients. A Boari bladder flap was used in 10 of the 12 patients (83%) in group 1 and 10 of the 17 (59%) in group 2. Concomitant downward nephropexy was done more commonly in group 1 (58% vs 12%, p = 0.014). At a mean followup of 11.4 months there was no difference in the overall failure rate between groups 1 and 2 (17% vs 12%). Complications developed more frequently in group 1 (75% vs 35%, p = 0.060), hospital stay was longer (mean 8.0 vs 4.4 days, p = 0.017) and mean estimated blood loss was greater (447 vs 224 ml, p = 0.008). Conclusions: The Boari bladder flap procedure is a reliable technique to reconstruct ureteral strictures regardless of site. Renal mobilization with downward nephropexy is a useful adjunctive maneuver for proximal strictures. References 1 : Complications of transureteroureterostomy. J Urol1975; 113: 467. Link, Google Scholar 2 : Long-term results with renal autotransplantation for ureteral replacement. J Urol1986; 136: 1187. Link, Google Scholar 3 : Use of ileum as ureteral replacement in urological reconstruction. J Urol2009; 181: 177. Link, Google Scholar 4 : A critical appraisal of the Boari flap. BJU Int1982; 54: 682. Google Scholar 5 : Endopyelotomy associated ureteral necrosis: complete ureteral replacement using the Boari flap. J Urol1992; 148: 1490. 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More articles by this author Allen F. Morey Financial interest and/or other relationship with GlaxoSmithKline, Pfizer and AMS. More articles by this author Expand All Advertisement PDF downloadLoading ...